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AHCPR Awards $7.6 Million in Grants Designed to Improve Health Care Quality

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Press Release Date: Friday, April 17, 1998

HHS' Agency for Health Care Policy and Research (AHCPR) today is announcing eight grant awards designed to improve the quality of U.S. health care. Overall funding will total $7.6 million over five years.

"These research projects will help us build a better science base for measuring and improving quality of care," said HHS Secretary Donna E. Shalala. "They will provide new ways to measure quality and will offer comparative information that will help physicians and providers improve health care outcomes."

In his budget proposal for FY 1999, President Clinton is requesting $15 million to enable AHCPR to fund additional quality-related research.

"These projects and more like them will provide the scientific foundation for this Administration's efforts to improve the quality of health care for all Americans," said AHCPR Administrator John M. Eisenberg, M.D. "These projects provide new insights and understanding about our complex health care system."

AHCPR is poised to announce a series of grants designed to determine the impact of different features of health plans on outcomes and on the quality of care provided to patients with chronic illnesses. The agency has launched several quality-related projects in FY 1998 that will inform health care decisions. AHCPR recently funded a report on innovations in value-based purchasing, showing how a number of major corporations, businesses and health coalitions are using their market power to negotiate on quality as well as cost.

Earlier this year, AHCPR launched the Consumer Assessment of Health Plans survey (CAHPS®), a survey kit which can be used by employers, managed care plans and others to obtain consumers' views of the care they are receiving. The Medicare program is adopting CAHPS® for its managed care enrollees and the Office of Personnel Management will adopt CAHPS® for use by the Federal Employees Health Benefits Program.

Grants announced today are:

  • Pressure Ulcer Rates in Describing Nursing Home Quality. Principal investigator: Dan R. Berlowitz, M.D., M.P.H., Boston Medical Center, Boston, Mass.; Grant #HS09768. Total funding: $697,679.

    This study will examine the development of pressure ulcers and create a model to predict their occurrence. The model then will be used to adjust for patient risk while evaluating different methods of describing nursing home performance. Ultimately, these results will help provide information on the quality of nursing homes and how it can be improved.

  • Measuring and Improving Quality: Carotid Endarterectomy. Principal investigator: Mark R. Chassin, M.D., M.P.H., Mount Sinai School of Medicine, New York, N.Y.; Grant # HS09754. Total funding: $2,467,604.

    This project will investigate quality of care in carotid endarterectomy, a surgical procedure performed to prevent stroke in patients with lesions in their carotid arteries. The study will assess appropriate use, develop measures of appropriateness and then create an intervention designed to improve appropriateness.

  • Patient-based Quality Assessment for Chronic Disease. Principal investigator: Sheldon Greenfield, M.D., New England Medical Center Hospitals, Inc., Boston, Mass.; Grant #HS09756. Total funding: $576,844.

    This study will compare disease-specific measures of quality for patients with three chronic conditions (asthma, diabetes and lower back pain) with general measures of quality (such as HEDIS 3.0 and CAHPS®) reported by the population being served in the health plan. It will determine whether these disease-specific measures are more sensitive than general measures in discriminating quality among health plans. The research also will examine whether comprehensive profiles of health plans can be created across disease conditions. If these measures are found to be valid, they could be used as measures for comparing health plans.

  • Understanding Clinical and Administrative Outcomes. Principal investigator: Jeremy Holtzman, M.D., M.S., University of Minnesota, Minneapolis, Minn.; Grant # HS09735. Total funding: $263,458.

    This study examines whether patients' post-operative symptoms could be used as possible outcomes indicators for two Medicare groups: patients being treated for stomach pain after having gallbladder surgery and patients with pain or difficulty walking after having hip surgery. The study will identify: how severity of illness impacts symptom relief; whether good symptomatic outcomes (such as less post-operative pain) correlate with a better process of care; whether better symptomatic outcomes (i.e., better mobility) predict subsequent utilization of services; and whether symptomatic and functional outcomes can be inferred from utilization data. If service utilization is found to be an acceptable surrogate for symptomatic outcomes (i.e., better or worse post-operative status), then utilization data could be used in lieu of more costly administrative data.

  • Validation of Quality Measures for Hip Replacement. Principal investigator: Jeffrey Katz, M.D., Brigham and Women's Hospital, Boston, Mass.; Grant # HS09775. Total funding: $472,306.

    This project will create quality indicators for elective total hip replacement, using information from medical record reviews and hospital and patient surveys. Currently, there are no validated measures of quality for total hip replacement. This research also will develop a cumulative index of quality, which could have implications for other surgical and medical interventions.

  • Predicting Risk for Hysterectomy Complications. Principal investigator: Evan Robert Meyers, M.D., M.P.H., Duke University Medical Center, Durham, N.C.; Grant # HS09760. Total funding: $254,550.

    This project will create predictive models that can be used by physicians and patients when making decisions about surgery. Hysterectomy is a procedure with a high level of unexplained variation in use and complications, especially among minorities. Methods for estimating and adjusting risk and severity are necessary to make comparisons of performance among providers who may be treating patients with conditions of greater severity and higher risk.

  • Quality Improvement for Newborns with Jaundice. Principal investigator: R. Heather Palmer, M.B., B.Ch., S.M., Harvard School of Public Health, Boston, Mass.; Grant # HS09782. Total funding: $2,449,037.

    Jaundice in the first few days of life can be a signal of serious, even devastating illness. The American Academy of Pediatrics has issued an evidence-based clinical guideline to identify infants with jaundice and prevent them from progressing to serious illnesses. Different implementation strategies of this guideline will be tested in loosely structured managed care settings. This common form of managed care is very different from the tightly structured HMO systems in which quality improvement has most often been studied.

  • Quality Improvement in Nursing Homes. Principal investigator: Francois Sainfort, Ph.D., University of Wisconsin, Madison, Wis.; Grant # HS09746. Total funding: $397,332.

    Very little is known about the influence of both organizational structure and culture on quality of care in the nursing home field. This project will examine the impact of quality improvement activities in 100 nursing homes in Wisconsin. This research will be of use to nursing homes seeking to implement a quality improvement philosophy within their facilities.

For additional information, please contact AHCPR Press Office: Salina Prasad, (301) 427-1864 (

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